Provider Demographics
NPI:1922334242
Name:INDIVIDUAL HOME CARE, INC.
Entity Type:Organization
Organization Name:INDIVIDUAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-872-2189
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0455
Mailing Address - Country:US
Mailing Address - Phone:304-872-2189
Mailing Address - Fax:304-872-2189
Practice Address - Street 1:77 PUDDY RUN RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651
Practice Address - Country:US
Practice Address - Phone:304-872-2189
Practice Address - Fax:304-872-2189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIVIDUAL HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-21
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1046-9961251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0031070000Medicaid